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Ann Thorac Surg 2004;77:1145
© 2004 The Society of Thoracic Surgeons

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Ethics in cardiothoracic surgery

The surgeon's work in transition: should surgeons spend more time outside the hospital?

^a School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
^b Division of Cardiothoracic Surgery, Oregon Health & Science University, Portland, Oregon, USA
^c Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas, USA
^d Division of Cardiothoracic Surgery and Institute of Human Values in Health Care, Medical University of South Carolina, Charleston, South Carolina, USA

Libby Zion was an 18-year-old college student who died in a New York City emergency room in 1984. Her father, a newspaper columnist and former federal prosecutor, sued the hospital and campaigned against long working hours for residents. As a result, New York State passed the "Libby Zion Law" in 1989, limiting work hours for house officers [1]. Ever since then, events have moved steadily, albeit in fits and starts, toward a conclusion that now seems to have been inevitable. The national 80-hour workweek mandated for house officers by the Accreditation Council for Graduate Medical Education has begun, and the disruption of traditional work schedules will be dealt with more or less effectively in medical graduate training programs around the country [2].

We do not know what effect these changes will have on the profession of surgery, but most of us strongly suspect that it will not be good. At the very least, surgeons of the future are likely to have a work ethic that is different from the one we acquired during and after our training. In fact, a shift in attitude toward work seems to be well underway already. Applications to general surgical training programs have been in progressive decline over the last few years. Much of the decline seems to be related to changes in professional expectations of medical students. These students want controlled working hours and more dedicated time for family and leisure activities [3]. Perhaps the mandatory reduction in work schedule for residents will reawaken interest in surgical training. In any case, it appears that the era of the "24/7" availability of surgeons and 16 to 18 hour workdays (only 4 to 8 hours on weekend days with an occasional weekend off) may be ending and slowly fading into oblivion.

Assuming that this scenario of surgery's future is accurate, does it contain lessons for those of us still caught up in the old paradigm? Is there something to be said for or, perhaps, something to be gained from cardiothoracic surgeons joining the trend by adopting a more friendly family or personal lifestyle attitude toward the distribution of our waking hours?

The question of more time for surgeons outside the hospital was debated at The Southern Thoracic Surgical Association Annual Meeting in November 2002. The topic of the debate was "The surgeon's work in transition: surgeons should cut back on time in the hospital to spend more time with family and personal interests." Ross Ungerleider argued the affirmative position, and Joseph Coselli argued the negative position. Their positions are presented with the assistance of co-authors in the following essays.

References

1. Robins N. The girl who died twice: every patient's nightmare: the Libby Zion case and the hidden hazards of hospitals. . New York: Delacorte Press, 1995.
2. Lowenstein J. Where have all the giants gone? Reconciling medical education and the traditions of patient care with limitations on resident work hours. Perspect Biol Med 2003;46(2):273-282.[Medline]
3. Bland K.I., Isaacs G. Contemporary trends in student selection of medical specialties: the potential impact on general surgery. Arch Surg 2002;137(3):259-267.[Abstract/Free Full Text]

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This Article Full Text (PDF) See related article (Pro) See related article (Con) See related article (Conclusion) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Ross M. Ungerleider Joseph S. Coselli Lori D. Conklin Robert M. Sade Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dickey, J. Articles by Sade, R. M. Search for Related Content PubMed Articles by Dickey, J. Articles by Sade, R. M. Related Collections Professional affairs